Endoscopic ultrasonography restaging of oesophageal cancer: linear, radial or nothing?
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Biomedical subjects
Publications and source records attributed to P Fusaroli.
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Light (LM) and electron microscopy (EM) were used to investigate the structural relationship between enteric nerves and the population of immune cells in the mouse small bowel. By LM, the osmium-zinc iodide procedure was used for visualizing nerve fibers; the incidence of nerve-plasma cell contacts in the mucosa and submucosa was calculated to be approximately 4 times and, respectively, 3 times greater than would be expected by chance alone (P < 0.0001). EM revealed close, synaptic-like contacts between axonal varicosities and plasma cells or B immunoblasts. The results presented here provide systematic quantitative evidence that a structural foundation for communication between nerve fibers and B cells exists in the mouse small bowel.
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Large gastric folds are seen in a great number of benign and malignant conditions. Diagnosis is a clinical challenge because the etiology may be extremely varied and standard biopsies are often inconclusive. The gastric wall is considered thickened at endosonography when it is more than 3.6 mm in width. Different diseases show different levels of infiltration of the gastric wall. When abnormalities involve the second layer only, benign conditions can be considered and standard endoscopic biopsies are often diagnostic. When abnormalities involve layers two and three, different diseases can be suspected, including Helicobacter pylori infection and lymphoma; in this case large-particle biopsy should be considered. When abnormalities involve layer four, malignancy should be strongly suspected even if standard or large-particle biopsies are negative. Endosonography, always in combination with fine-needle or guillotine-needle biopsy, should be able to rule out malignancies and to select the most appropriate treatment for each patient.
Endoscopic ultrasonography (EUS) is nowadays a clinically relevant technology and its findings can have a major impact on patient management. This technique is currently indicated for staging digestive cancers, assessment of submucosal tumors, diagnosis of intestinal wall infiltrative diseases, common bile-duct stones and gut neuroendocrine tumors. As far as neoplasms are concerned, EUS appears to be a reliable and safe technique, thus making the physician able to plan either an aggressive surgical treatment, or a conservative palliative therapy. This is of the utmost importance in order to optimize medical-related costs, and to make the best therapeutic decision for each individual patient. EUS is also helpful in monitoring the course of a disease, as it is simple and virtually without complications. When EUS findings are not sufficient for a complete diagnosis, it is now possible to perform an EUS-guided fine-needle biopsy, which can allow a cytological diagnosis. Finally, some therapeutic endosonography-guided procedures are being increasingly adopted, such as cystoenterostomy, celiac plexus neurolysis, cholangio-pancreatography and selective injection of botulinum toxin in the muscle layer of the lower esophageal sphincter.
Cholestasis syndromes are characterized by a reflux of compounds usually excreted with bile. ATP dependent carriers and cytoskeleton proteins guarantee physiological bile flux. There are several clinical conditions in which this system is affected. Intrahepatic cholestasis is characterized by damage to hepatocytes or intrahepatic bile ducts. Primary biliary cirrhosis and primary sclerosing cholangitis represent examples of cholestatic chronic liver disease. The pathogenesis of these two conditions seems to be mediated by immunological reactions. Moreover, hepatitis viruses are able to induce cholestasis.
Intraepidermal free nerve endings were investigated in the mouse snout skin by means of an immunohistochemical procedure using a rabbit antiserum against protein gene product 9.5 (PGP 9.5). Immunoperoxidase reactivity was detected in different subtypes of intraepidermal nerves and cells. The great majority of axons observed in the stratified epithelium were varicose; a small percentage was either smooth (non-varicose) or irregularly shaped. Intraepidermal nerves ended at different levels within the epidermis, often with a terminal knob-like swelling. Various patterns of intraepidermal innervation could be distinguished. Most fibres entering the epidermis originated from large bundles running a horizontal course below the dermo-epidermal junction. Such fibres ascended vertically through the stratified epithelium in a "candelabrum-like" fashion, without emitting collaterals. Other fibres branched profusely and ended in complex intraepidermal neural networks. Less frequently, intraepidermal fibres terminated with large irregularly shaped expansions of different morphologies. Some of these were the intraepidermal continuations of axons within Meissner's corpuscles. Some fibres appeared to come into contact with PGP 9.5-immunoreactive cells (which closely resembled Merkel cells) located in the stratum basale. Rare suprabasal dendritic cells (Langerhans cells?) also became visible.
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Specific catecholaminergic granules had been previously described in the endothelial cells of blood and lymphatic vessels. 2 histochemical techniques were used in this work for detecting catecholamines in human coronary vessels: both the postfixation with OsO4-KI mixture and the formaldehyde induced fluorescence (FIF) reaction. Ultrastructural examinations of bioptic specimens processed with the OsO4-KI staining showed a marked positivity in the coronary endothelial cells, as well as in the smooth muscle fiber cells of the coronary arteriolae and the adventitial nerve endings. These findings were confirmed by a high level of fluorescence in the same structures, obtained using the FIF reaction. Myocardial fiber cells never reacted. Therefore, an important role of the endothelium of human coronary vessels in the turn-over of catecholamines could have been supposed.
We used the simple method of direct cytofluorescence to detect the presence of the aminoglycoside, streptomycin, in the inner ear after its systemic administration. In the cochlea, fluorescence was observed in the organ of Corti, the spiral ganglion, the nerve fibres, the vascular stria and Reissner's membrane; in the vestibulum, fluorescence was seen in the crista ampullaris and the planum semilunatum. The localization of the drug was related to the distribution of its specific receptor, triphosphoinositide (TPI); therefore, it is reasonable to assume that aminoglycosides exert their toxic effects by binding to TPI.
A simple osmium-potassium-iodide post-fixation procedure for brightly and specifically visualizing melanocytes of human epidermis on semithin sections is described.
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